S T A T E O F N E W Y O R K
________________________________________________________________________
5854--A
2021-2022 Regular Sessions
I N A S S E M B L Y
March 1, 2021
___________
Introduced by M. of A. JOYNER, COOK, AUBRY, LAVINE, RODRIGUEZ, SIMON,
STECK, GALEF -- read once and referred to the Committee on Insurance
-- committee discharged, bill amended, ordered reprinted as amended
and recommitted to said committee
AN ACT to amend the insurance law, in relation to the purchase of
prescription drugs
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 28 of subsection (i) of section 3216 of the
insurance law, as amended by chapter 11 of the laws of 2012, is amended
to read as follows:
(28) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
(I) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
UNDER SUBPARAGRAPH (B) OF THIS PARAGRAPH SHALL PROVIDE THE SAME BENCH-
MARK INDEX, INCLUDING THE SAME AVERAGE WHOLESALE PRICE, MAXIMUM ALLOW-
ABLE COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMA-
CIES PARTICIPATING IN THE INSURANCE NETWORK REGARDLESS OF WHETHER A
PHARMACY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
(II) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
TO RECEIVE PRESCRIPTIONS BY MAIL, TELEFAX OR THROUGH ELECTRONIC
SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
TO-FACE.
(B) Any policy that provides coverage for prescription drugs shall
permit each insured to fill any covered prescription that may be
obtained at a network participating mail order or other non-retail phar-
macy, at the insured's option, at a network participating non-mail order
retail pharmacy provided that the network participating non-mail order
retail pharmacy agrees [in advance, through a contractual network agree-
ment,] to the same reimbursement amount[, as well as the same applicable
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03918-03-1
A. 5854--A 2
terms and conditions,] that the insurer has established for the network
participating mail order or other non-retail pharmacy. In such a case,
the policy shall not impose a co-payment fee or other condition on any
insured who elects to purchase prescription drugs from a network partic-
ipating non-mail order retail pharmacy which is not also imposed on
insureds electing to purchase drugs from a network participating mail
order or other non-retail pharmacy; PROVIDED, HOWEVER, THAT THE
PROVISIONS OF THIS SUBPARAGRAPH SHALL NOT SUPERSEDE THE TERMS OF A
COLLECTIVE BARGAINING AGREEMENT OR APPLY TO A POLICY THAT IS A RESULT OF
A COLLECTIVE BARGAINING AGREEMENT BETWEEN AN EMPLOYER AND A RECOGNIZED
OR CERTIFIED EMPLOYEE ORGANIZATION.
§ 2. Paragraph 18 of subsection (l) of section 3221 of the insurance
law, as amended by chapter 11 of the laws of 2012, is amended to read as
follows:
(18) (A) DEFINITIONS. FOR THE PURPOSE OF THIS PARAGRAPH:
(I) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
UNDER SUBPARAGRAPH (B) OF THIS PARAGRAPH SHALL PROVIDE THE SAME BENCH-
MARK INDEX, INCLUDING THE SAME AVERAGE WHOLESALE PRICE, MAXIMUM ALLOW-
ABLE COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMA-
CIES PARTICIPATING IN THE INSURANCE NETWORK REGARDLESS OF WHETHER A
PHARMACY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
(II) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
TO RECEIVE PRESCRIPTIONS BY MAIL, TELEFAX OR THROUGH ELECTRONIC
SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
TO-FACE.
(B) Any insurer delivering a group or blanket policy or issuing a
group or blanket policy for delivery in this state that provides cover-
age for prescription drugs shall permit each insured to fill any covered
prescription that may be obtained at a network participating mail order
or other non-retail pharmacy, at the insured's option, at a network
participating non-mail order retail pharmacy provided that the network
participating non-mail order retail pharmacy agrees [in advance, through
a contractual network agreement,] to the same reimbursement amount[, as
well as the same applicable terms and conditions,] that the insurer has
established for the network participating mail order or other non-retail
pharmacy. In such a case, the policy shall not impose a co-payment fee
or other condition on any insured who elects to purchase drugs from a
network participating non-mail order retail pharmacy which is not also
imposed on insureds electing to purchase drugs from a network partic-
ipating mail order or other non-retail pharmacy; provided, however, that
the provisions of this section shall not supersede the terms of a
collective bargaining agreement or apply to a policy that is the result
of a collective bargaining agreement between an employer and a recog-
nized or certified employee organization.
§ 3. Subsection (kk) of section 4303 of the insurance law, as amended
by chapter 11 of the laws of 2012 and as relettered by section 55 of
part D of chapter 56 of the laws of 2013, is amended to read as follows:
(kk) (1) DEFINITIONS. FOR THE PURPOSE OF THIS SUBSECTION:
(A) "SAME REIMBURSEMENT AMOUNT" SHALL MEAN THAT ANY COVERAGE DESCRIBED
UNDER PARAGRAPH TWO OF THIS SUBSECTION SHALL PROVIDE THE SAME BENCHMARK
INDEX, INCLUDING THE SAME AVERAGE WHOLESALE PRICE, MAXIMUM ALLOWABLE
COST AND NATIONAL PRESCRIPTION DRUG CODES TO REIMBURSE ALL PHARMACIES
PARTICIPATING IN THE HEALTH BENEFIT PLAN REGARDLESS OF WHETHER A PHARMA-
CY IS A MAIL ORDER PHARMACY OR A NON-MAIL ORDER PHARMACY.
A. 5854--A 3
(B) "MAIL ORDER PHARMACY" MEANS A PHARMACY WHOSE PRIMARY BUSINESS IS
TO RECEIVE PRESCRIPTIONS BY MAIL, TELEFAX OR THROUGH ELECTRONIC
SUBMISSIONS AND TO DISPENSE MEDICATION TO PATIENTS THROUGH THE USE OF
THE UNITED STATES MAIL OR OTHER COMMON OR CONTRACT CARRIER SERVICES AND
PROVIDES ANY CONSULTATION WITH PATIENTS ELECTRONICALLY RATHER THAN FACE-
TO-FACE.
(2) Any contract issued by a medical expense indemnity corporation, a
hospital service corporation or a health services corporation that
provides coverage for prescription drugs shall permit each covered
person to fill any covered prescription that may be obtained at a
network participating mail order or other non-retail pharmacy, at the
covered person's option, at a network participating non-mail order
retail pharmacy provided that the network participating non-mail order
retail pharmacy agrees [in advance, through a contractual network agree-
ment,] to the same reimbursement amount[, as well as the same applicable
terms and conditions,] that the corporation has established for the
network participating mail order or other non-retail pharmacy. In such
a case, the contract shall not impose a copayment fee or other condition
on any covered person who elects to purchase drugs from a network
participating non-mail order retail pharmacy which is not also imposed
on covered persons electing to purchase drugs from a network participat-
ing mail order or other non-retail pharmacy; provided, however, that the
provisions of this section shall not supersede the terms of a collective
bargaining agreement or apply to a contract that is the result of a
collective bargaining agreement between an employer and a recognized or
certified employee organization.
§ 4. This act shall take effect immediately.